**Conflict of interest**

**vi.** poor vascular bed and perfusion leading to iii as well

while 1 mm of P1 shortening gives a 12°-extension lag [43]

hope of good functional outcome in crush injuries to the hand.

**xi.** skin closure under tension will result in ischemic and necrotic tips

fixation has to be very precise

**xii.** poor hand immobilization.

**6. Conclusion**

full flexion reveals more.

132 Essentials of Hand Surgery

**vii.** inadequate soft tissue cover especially over hardware or incorrect choice of implant size

**Figure 25. A:** extensor tendon repair with Vicryl 3/0 (yellow arrows)—it eroded the thin overlying dorsal skin. The screw heads (blue arrows) are way too big too. **B:** K-wires passed through the germinal matrix will result in nail deformities. **C, D:** an enormous K-wire driven through a 5-year-old's little finger causing sluggish venous return. **E:** wire removal decongests. **F:** a finer wire does the trick. **G:** no malrotation. **H:** on slight flexion, the malrotation of the ring is seen. **I:**

**ix.** malunion in terms of angulation or rotation—1° of MC rotation results in 5°of fingertip malrotation [43] and 5° of MC rotation ends up with 1.5 cm digital overlap [44], thus

**x.** malunion in terms of shortening—2 mm of MC shortening produces a 7° extension lag,

Thus as can be seen, most of the adverse outcomes can be avoided. The hand surgeon has a multitude of options in resurfacing the hand. Though there are challenges to be overcome, present day microsurgical and other techniques together with biological options offer the

These are devastating injuries that are daunting; however, after the patient is stabilized and initial first aid is administered, the assessment should provide a checklist of what is damaged, and what is available for reconstruction; this would include what may be "scavenged" from the parts that are not reattachable—such as skin, parts of bone, even tendons nerves and vessels. The most challenging part is for the surgeon to accept that a "normal" hand will not result

**viii.** placing fixation through the germinal or sterile matrix resulting in nail deformities

The authors declare no conflict of interest and have not received any remuneration or benefit from any entity for the writing or publication of this article.
